Healthcare Provider Details

I. General information

NPI: 1831028026
Provider Name (Legal Business Name): VICTOR JUAREZ LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 NORTH RD STE 103
POUGHKEEPSIE NY
12601-1173
US

IV. Provider business mailing address

82 WASHINGTON ST STE 100
POUGHKEEPSIE NY
12601-2305
US

V. Phone/Fax

Practice location:
  • Phone: 845-790-6136
  • Fax: 845-790-6136
Mailing address:
  • Phone: 845-790-6136
  • Fax: 845-790-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number337745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: